Being humbled by a coworker...

[begoodlpn]

I had an interesting and humbling experience today. I'm a new grad and was lucky to start a hospital position on a med-surg floor. I was going to give a norco when one of my co-workers, an RN, asked why I was preparing to give a PRN Norco. I said it was within the time allotted and the patient ranked their surgical incision pain as an 8/10. I've done this 50 times since I started working a few months ago. The other LPNs do the same thing, the LPNs and RNs share the patient load and this patient was under my care.

Now, this person/RN doesn't regularly work our floor but seemed to be verging on rude or simply boldly inquisitive. Yet, they really made me think and stop to question myself and if I'm practicing outside of my license- if all LPNs are practicing outside of their license.

The RN said that performing a pain assessment (1-10 scale) is still an assessment. She was very clear as I'm very aware LPNs are not allowed to perform assessments. She then pushed it further to giving scheduled BP meds and checking blood pressure. Should I even be giving scheduled BP meds since I'm only to collect the data, not interpret whether it is acceptable or unacceptable. This RN just kept going on and on.

I was lost and felt very flustered. I didn't know how to respond. I felt so stupid because I could see her point but then again most of my LPN training was with regards to assessment! How can I not take a patient's pain scale and interpret it? I always felt so autonomous in my role. The RN would always do the head to toe assessment each morning for all 6 of our patients while I did med pass for them. After that, I was to be in charge of 3 patients while she took over for the other three. From my understanding that is how that floor has always worked.

Later that day another LPN asked me if I should even be responding to the patient when I ask their name and date of birth- apparently that would be an assessment and I should report it immediately to the supervising RN to be sure that she can interpret it before I give any medication.

I just felt so humbled- is that even the right word? I felt below my ability like there are people out there that think less of me for my license. Am I just a medications aide? I do IVs and foleys and the occasional enema. Is that all I'm good for? Am I just to do tasks and not act on information provided by the patient such as pain scale when I have a PRN order? Am I not allowed to count respirations before giving that Norco or document the stated pain number? Should that be the RNs responsibility? Should the RN be in charge of all PRN medications? Are PRN medications outside of the LPNs scope of practice because they require an assessment?

I've turned this into a very very long rant. I just can't help but think, what if she's right?

:edit: i attached my state's practice act below for further clarification.

[begoodlpn]

I looked up my practice act just to reinforce what I'm doing...... Here is what it specifically says:

Rule 3. Licensed Practical Nursing

848 IAC 2-3-1 Responsibility to apply the

nursing process

Authority: IC 25-23-1-7

Affected: IC 25-23

Sec. 1. The licensed practical nurse shall do the

following:

(1) Know and utilize the nursing process in

planning, implementing, and evaluating health

services and nursing care to the individual

patient or client.

(2) Collaborate with other members of the health

team in providing for patient/client participation in

health promotion, maintenance, and restoration.

(3) Seek educational resources and create

learning experiences to enhance and maintain

current knowledge and skills for his or her

continuing competence in nursing practice and

individual professional growth.

(4) Assess the health status of the patient/client,

in conjunction with other members of the health

care team, for analysis and identification of

health goals.

(5) Evaluate with the patient/client the status of

goal achievement as a basis for reassessment,

reordering of priorities, and new goal setting for

contribution to the modification of the plan of

nursing care.

(Indiana State Board of Nursing; 848 IAC 2-3-1;

filed Oct 25, 1991, 5:00 p.m.: 15 IR 244;

readopted filed Nov 6, 2001, 4:18 p.m.: 25 IR

939; readopted filed Jul 19, 2007, 12:54 p.m.:

20070808-IR-848070058RFA)

848 IAC 2-3-2 Responsibility as a member of

the health team

Authority: IC 25-23-1-7

Affected: IC 25-23

Sec. 2. The licensed practical nurse shall do the

following:

(1) Function within the legal boundaries of

practical nursing practice based on the

knowledge of statutes and rules governing

nursing.

(2) Accept responsibility for individual nursing

actions and continued competence.

(3) Communicate, collaborate, and function with

other members of the health care team to

provide safe and effective care.

(4) Seek education and supervision as

necessary from registered nurses and/or other

members of the health care team when

implementing nursing techniques or practices.

(5) Respect the dignity and rights of the

patient/client regardless of socioeconomic status,

personal attributes, or nature of health problems.

(6) Maintain each patient/client's right to privacy

by protecting confidential information unless

obligated, by law, to disclose the information.

(7) Provide nursing care without discrimination

on the basis of diagnosis, age, sex, race, creed,

or color.

(8) Accept only those delegated nursing

measures which he or she knows he or she is

prepared, qualified, and licensed to perform.

(9) Respect and safeguard the property of

patient/client, family, significant others, and the

employer.

(10) Notify, in writing, the appropriate party which

may include:

(A) the office of the attorney general, consumer

protection division;

(B) his or her employer or contracting agency; or

© the board;

of any unprofessional conduct which may

jeopardize the patient/client safety.

(11) Participate in the review and evaluation of

the quality and effectiveness of nursing care.

(Indiana State Board of Nursing; 848 IAC 2-3-2;

filed Oct 25, 1991, 5:00 p.m.: 15 IR 244;

readopted filed Nov 6, 2001, 4:18 p.m.: 25 IR

939; readopted filed Jul 19, 2007, 12:54 p.m.:

20070808-IR-848070058RFA)

According to this practice act, am I doing something wrong with giving PRN medication? Is checking BP, taking a pain score, or counting respiration truly an assessment only an RN can perform and interpret?

[LadyFree28, BSN, LPN, RN]

Nope, because of #8...according to facility policy and the NPA, you are able to do assessment through data collection, which include vitals, including pain scale, and you can utilize interventions by medicating the pt, which is applicable that you have the competence to perform those duties independently. If anything, the nurse wanted you to think deep enough into the WHY...That under your NPA, you data collect, and can perform interventions that are in the plan of care, while collaborating with the RN...the pint is to say data collect, then intervene based on the findings, and that the medicine has been effective based in previous findings. That's how you rationalize your role as the Practical nurse on the team. :)